W6-Depression Scenarios

Post#2 Depression Scenarios by Beatrice Nerettes

1-There is no response to the medication.

The purpose of this discussion post is to further elaborate on the course of treatment for Alison. Alison was started on Mirtazapine 7.5 mg at bedtime and reports that she feels the medication is not working after taking the medication for six weeks. My course of treatment plan would be to increase the dosage of mirtazapine from 7.5mg to 15mg at bedtime. “Depressed mood and lack of interest in activities may need up to 6-8 weeks to fully improve” (Mirtazapine (Remeron) n.d). Increase medication dosage and continue to monitor Alison.

2-There is a partial response to the medication. The mood has lifted, but energy and motivation are still poor.

Despite Alison reporting partial response to mediation, the mood has lifted, but energy and motivation are still poor. Some essential questions to ask Alison are whether she has experienced an improvement in sleep or appetite, which can be a clear indicator of whether the medication is working. “Sleep, energy, or appetite may show some improvement within the first 1-2 weeks (Mirtazapine (Remeron) n.d). Improvement in these physical symptoms can be an important early signal that the medication is working” (Mirtazapine (Remeron) n.d). If Alison reports increased sleep and appetite, the course of treatment would be to continue with Mirtazapine 15mg-QHS.

3-The mood is improved, but the patient has sexual side effects that interfere with their quality of life.

One of the main side effects of taking medications to treat any form of major depression can be decreased libido. Typically, selective serotonin reuptake inhibitors or SSRIs can help lift people out from under a dark cloud of depression, causing decreased interest in sex or even inability to experience orgasm (When an SSRI medication impacts your sex life, 2019). On the contrary, certain antidepressants, such as bupropion, and mirtazapine are less likely to cause sexual problems (When an SSRI medication impacts your sex life, 2019). I would continue Alison on mirtazapine 15mg but provide her with resources to help with improving her sex drive. One suggestion would be for Alison to schedule sex. Often if sex is scheduled before taking medication, it can help with improving sex drive (When an SSRI medication impacts your sex life, 2019). If Alison reports medication interfering with the quality of sex life during our next follow-up appointment, I will prescribe Wellbutrin SR 100mg every morning. One of the main goals of Wellbutrin is to restore the balance of both dopamine and norepinephrine in the brain (Bupropion hcl SR 100 mg tablet,12 hr sustained-release, n.d). Also, individuals prescribed Wellbutrin experience minimal side effects to sex drive.

References:

Bupropion HCL SR 100 mg tablet,12 hr sustained release. bupropion HCl SR 100 mg tablet,12 hr sustained release | Kaiser Permanente. (n.d.). Retrieved October 9, 2021, from https://healthy.kaiserpermanente.org/health-wellness/drug-encyclopedia/drug.bupropion-hcl-sr-100-mg-tablet-12-hr-sustained-release.208628.

Mirtazapine (Remeron). NAMI. (n.d.). Retrieved October 8, 2021, from https://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Types-of-Medication/Mirtazapine-(Remeron).

When an SSRI medication impacts your sex life. Harvard Health. (2019, October 22). Retrieved October 9, 2021, from https://www.health.harvard.edu/womens-health/when-an-ssri-medication-impacts-your-sex-life.